| NPI | 1174969224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1229901) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 1229901) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2019-07-23 |